Healthcare Provider Details

I. General information

NPI: 1922093368
Provider Name (Legal Business Name): JULIO ARMANDO MARRERO-GUADALUPE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. EL JIBARO CARR. 172 KM. 13.5 BO. BAYAMON
CIDRA PR
00739-1330
US

IV. Provider business mailing address

PO BOX 32
CAGUAS PR
00726-0032
US

V. Phone/Fax

Practice location:
  • Phone: 787-739-8182
  • Fax: 787-739-8190
Mailing address:
  • Phone: 787-502-3492
  • Fax: 787-739-8190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12356
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: